ECDC and WHO call for better prevention, diagnosis and treatment for vulnerable populations, including migrants and refugees

With HIV infection diagnosed in over 142 000 people in 2014, the WHO European Region recorded the highest number of newly diagnosed infections in 1 year since the start of reporting in the 1980s. The most recent surveillance data released by the European Centre for Disease Prevention and Control (ECDC) and the WHO Regional Office for Europe indicate that the growth of the HIV epidemic is driven by the eastern part of the Region, where the number of new diagnoses has more than doubled during the past decade.

Heterosexual transmission is responsible for the increase in eastern Europe, and transmission through drug injection remains substantial. In the EU and the EEA, sex between men is the predominant mode of HIV transmission. Two in three new HIV infections are among native-born Europeans, while foreign-born individuals, including migrants, represent only one third of HIV diagnoses.

"Despite all the efforts to fight HIV, this year the European Region has reached over 142 000 new HIV infections, the highest number ever. This is a serious concern", says Dr Zsuzsanna Jakab, WHO Regional Director for Europe. "With all the evidence on HIV prevention and control, including new treatment guidelines, we call on European countries to take bold action and curb the HIV epidemic once and for all".

"Since 2004, the rates of new diagnoses have more than doubled in some EU and EEA countries and decreased by 25% in others. But the overall HIV epidemic persists largely unchanged", points out ECDC Acting Director Andrea Ammon. "This means that the HIV response in the EU and EEA has not been effective enough to result in a noticeable decline over the last decade."

Social exclusion places refugees and migrants at greater risk of HIV infection

During the past decade, the number of diagnoses of HIV infection in migrants in Europe has declined sharply, and evidence shows that a significant proportion acquire HIV after arrival in Europe.

"Refugees and migrants remain a priority for HIV prevention and care. Conflict and disasters should not affect access to HIV services for people living with HIV. When refugees and migrants are victims of social exclusion in receiving countries, they are at greater risk of HIV infection, and this may lead them to engage in risky behaviour, increasing their risk for infection. This risk is exacerbated by inadequate access to HIV services and fear of being stigmatized", stresses Dr Jakab. "We at WHO urge all countries in Europe to offer HIV prevention, testing and treatment services to all refugees and migrants, irrespective of their legal status. This is also the safest way to protect the resident population from HIV infection".

Sex between men the main transmission mode in the EU and EEA

Despite specific prevention programmes in many European countries, sex between men is still the predominant mode of HIV transmission in the EU and EEA. "HIV diagnoses among men who have sex with men have been rising at an alarming rate, from 30% in 2005 to 42% in 2014, with increases in all but six EU and EEA countries", highlights ECDC Acting Director Andrea Ammon. "Europe has to scale up its efforts to reach out to this group. This includes looking at new strategies such as pre-exposure prophylaxis for HIV and access to care for EU citizens residing in other EU countries." In its new guidance, ECDC identifies seven key services that have been proven to be effective in reducing and preventing HIV infection among men who have sex with men.

The obstacle to ending AIDS: late diagnosis

Almost half of HIV infections throughout the European Region are diagnosed late: this increases the risks for ill health, death and HIV transmission. The high number of AIDS cases in the eastern part of the Region confirms the role of late HIV diagnosis, delayed initiation of antiretroviral therapy (ART) and low treatment coverage. The number of AIDS cases is going down continuously in the EU and EEA. But two thirds of AIDS diagnoses reported in 2014 occurred at the time of or shortly after the HIV diagnosis, indicating that the immune system of these people had already started to fail. Migrants are more likely to have a late diagnosis, but only half of EU and EEA countries provide free treatment for undocumented migrants.

New global HIV guidelines improve prevention and treatment

In 2015, new WHO global HIV prevention and treatment guidelines were issued, suggesting that ART should be initiated in all people living with HIV, irrespective of their CD4 cell count. There is now strong evidence that early treatment is beneficial both for the health of treated individuals and in preventing onward HIV transmission.

However, early testing, support by trained lay providers and potential use of HIV self-testing should be scaled up in order to make this new opportunity available to infected people. This will ensure earlier diagnoses and treatment initiation, resulting in improved treatment outcomes and less disease and death.